Saturday, June 04, 2005

DWM - Classics in Epidemiology and Statistics

BrooklynDodger was ADDing on the question of epidemiological evidence for causation when the Dodger made three discoveries. We all refer to the "Bradford Hill" "criteria." First, the "A" in Bradford Hill stands for Austin, not Arthur. Second, while this paper reads like a Brit after dinner speach at some meeting, it was the Presidential Address to the Occupational section of the British Medical Association. Third, Sir Austin was trained as an economist, he never went to epidemiology school.

The actual text of this address is hard to get in full text because it goes back to 1965, actually not so long ago.

"On fair evidence we might take action on what appears to be an occupational hazard, e.g. we might change from a probably carcinogenic oil to a noncarcinogenic oil in a limited environment and without too much injustice if we are wrong. But we should need very strong evidence before we made people burn a fuel in their homes that they do not like or stop smoking the cigarettes and eating the fats and sugar that they do like [1](p.300)."

So present day public health has pretty much 180'd this prescription. OSHA has refused to reduce the exposure limit for metalworking fluids in the face of consensus that asthma and HP appear with greater frequency when exposures exceed 0.5 mg/M3 [compared to a current limit of 5], and a dozen studies showing increased mortality from cancer at a variety of sites. Meanwhile, all the energy is going into health risk behavior, without much of a clue as to how to change that behavior.

For historical value, references to the first studies proving increased risk for lung cancer from cigarettes are reproduced below.

The missed lessons of Sir Austin Bradford Hill

Carl V Phillips1, 2, 3 and Karen J Goodman1

1Management, Policy and Community Health Division, University of Texas School of Public Health, 1200 Pressler, Houston, TX 77225, USA2Center for Clinical Research and Evidence-Based Medicine, University of Texas Medical School, Houston, TX USA3Center for Philosophy, Health, and Policy Sciences, Inc, Houston, USA

Epidemiologic Perspectives & Innovations 2004, 1:3

Doll R, Hill AB. The mortality of doctors in relation to their smoking habits. Br Med J 1954;228:1451-5. Reproduced in: BMJ 2004;328:1529-3.

Doll R, Hill AB. Lung cancer and other causes of death in relation to smoking. A second report on the mortality of British doctors. BMJ 1956;233:1071-6.

Doll R, Peto R, Boreham J, Sutherland I. Mortality in relation to smoking: 50 years' observation on male British doctors. BMJ 2004;328:1519-33.

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